Hey guys, Nurse Mike here and welcome to SimpleNursing.com. Now before we get today's lecture started, please remember to access your free quiz and preview our cool nifty new study guides not here on YouTube. Click the link right up here at any time during this video. Alright guys, let's begin. You're the nurse in the emergency department and you have three patients.
Bob was in a car accident, Betty was stabbed in the chest, oh my gosh, and Tommy just had a heart attack waiting for his NCLEX results. They're all pale, cool and clammy with vital signs including tachycardia. Hypotension and low oxygen saturations. The heart monitor shows uneven QRS complexes.
OMG! What could it be? And what is the first thing you want to do as a nurse?
Today we're wrapping up cardiac tamponade or cardiac tamponade. So think compression on the heart so the heart can't pump out oxygen to the body. Now cardiac tamponade comes from the root word tampon.
And since tampons fill with blood, well the sac around the heart fills up with either blood or fluid like a big water balloon, putting pressure on those ventricles which eventually stops the heart. No heartbeat means we have a dead patient, right? Everyone knows this, but why though?
This is because the heart pumps out oxygen-rich blood out to the body, called cardiac output. This compression on the heart causes a dramatic drop in cardiac output, meaning drop in blood to the body. Or in other words, low cardiac output means low oxygen put out to the body. Because guys, remember this one thing, and we always say it here.
Oxygen is the money of the body. No money, no honey. So, no oxygen, no life. Now, the fancy medical definition for cardiac tamponade is when the pericardial sac around the heart fills with fluid or blood, causing increased pericardial pressure that compresses the heart so the heart no longer can fill with blood. So, if the heart can't get blood in, well then, guys, it can't get blood out.
And again, this low cardiac output means low oxygen put out to the body. So what's really going on in the body? Well as you guys know, the heart is protected by a double layered sac called the pericardium, which acts kind of like a waterbed to protect the heart. This sac is normally filled with about 30-50 mLs of fluid, and this helps lubricate the heart layers, which minimizes friction as the heart contracts.
But in cardiac tamponade, blood or fluid fills up the sac around the heart which compresses the ventricles. causing deadly low cardiac output this low blood being pumped out and guys eventually this leads to no pumping at all So we lose a heartbeat altogether and the patient dies So naturally all the signs and symptoms stem from this low cardiac output this low oxygen to the body So we'll see classic complaints from this low low oxygen and this low low blood pressure now the very first sign You'll see for low oxygen is always restlessness which is the earliest indication of hypoxemia. Just fancy words for low oxygen.
Now that's a huge test tip right there. This restlessness is also seen as ALOC, Alter Level of Consciousness, or they even call it a change in mental status. So we'll also see dizziness, or passing out, called syncope, fatigue, and shortness of breath, also called dyspnea, this difficulty breathing. Oh, and also we'll see tachycardia, which is the very first sign of decreased cardiac output. Now, that's a big test tip.
Now, why is tachycardia the very first sign of low cardiac output? Well, as the body starves for oxygen, the heart tries to compensate by pumping faster and faster to move its limited blood supply and oxygen around the body. Now, in cardiac tamponade, as the heart gets squished, a condition called Beck's triad occurs.
So use this helpful acronym. These are very classic signs and symptoms. of cardiac tamponade.
Now the B stands for big jugular vein distension also called JVD. Our E stands for extremely low blood pressure aka hypotension. And the C you can't hear the heart sounds because they're muffled by all that fluid around the heart. Now another problem from the heart getting squished is something called pulses paradoxes where the blood pressure also gets squished down too.
So that's a huge test up right there. Write that one down. Now why does this happen? Well, as blood coming out of the heart decreases, aka decreased cardiac output, well the stress put on those blood vessels decreases too, showing a drop in that systolic blood pressure, that top number.
So a drop in systolic blood pressure by more than 10 mmHg during inspiration or breathing in, this leads to narrow pulse pressure, meaning the top and bottom numbers are getting closer and closer together. So for example, 120 over 80 has a normal pulse pressure of 40. But as the heart gets compressed, the numbers get compressed too, and the pulse pressure gets more narrow. So it gets to like 100 over 90, that's a pulse pressure of 10. Now as far as the heart waves on the cardiac monitor, it's going to show uneven low voltage waves in our QRS complex.
But why? Well, just think of the patho here, guys. We have a heart that is getting squished, right?
Well, our big ventricles squeeze those QRS complexes. Thanks for watching. For our full video and new QuizBank... click right up here to access your free trial.
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